If You Took The Nicotine Out Of Cigarettes, Would Fewer People Want To Smoke?

Not many people do. They were on the U.S. market from 2002 to 2010, and their selling point—and possibly their downfall—was that they were made from specially cultivated tobacco that naturally contained far lower levels of nicotine than tobacco used in conventional cigarettes.

More than a decade before Vector Tobacco introduced Quest, Philip Morris test-marketed “de-nicotinized” cigarettes. They were made of conventional tobacco from which nicotine, among other things, had been extracted, kind of like how decaffeinated coffee is made from extracting caffeine from coffee beans. They were marketed under the names "Merit Free" and "Next." Don't remember them? The problem is that the de-nicotinizing process also removed compounds that make cigarettes taste good to smokers.

Nicotine is the addictive component in tobacco, but it doesn't cause most smoking-related diseases, such as lung cancer. That distinction belongs to the thousands of other compounds released when smokers light up cigarettes.

If you could get smokers to turn to non-combustible nicotine delivery devices such as vaporizers and e-cigarettes to satisfy their cravings, the thinking goes, you could reduce their risk of harm from smoking. One way to get smokers to switch to these alternative sources of nicotine, according to Dr. Scott Gottlieb, commissioner of the Food and Drug Administration, and like-minded scientists, would be to cut the amount of nicotine in cigarettes to barely a trace.

(Daniel Acker/Bloomberg)

Gottlieb, who, interestingly, until May 2016 served on the board of Kure, a company that franchises vaping lounges and sells vaping paraphernalia, has asked the FDA’s Center for Tobacco Products “to develop a comprehensive nicotine regulatory plan premised on the need to confront and alter cigarette addiction.”

“Cigarettes will likely remain incredibly toxic, what with the presence of over 7,000 chemicals in cigarette smoke,” Gottlieb said in prepared remarks late last month. “But with a balanced regulatory approach, we may be able to reach a day when the most harmful products are no longer capable of addicting our kids.”

But will mandating low nicotine in all cigarettes prevent young people from getting hooked on smoking and drive smokers who are already addicted to other sources of nicotine? Or will it simply create a demand for black-market cigarettes with a higher nicotine content? (A cigarette black market in which people in states with high taxes on packs buy bootlegged packs from states with low taxes already exists.)

Anecdotally, Quest cigarettes, which came with three different levels of nicotine content, helped some smokers wean themselves off of the stimulant. But Americans' ignorance about what makes cigarettes unhealthy could prevent low-nicotine cigarettes from reducing the rates of smoking and smoking-related diseases, a recent report from researchers at the FDA's own Center for Tobacco Products suggested.

Their study, published this past March--just a couple of months before Gottlieb became commissioner--found that about three-quarters of U.S. adults surveyed by the FDA in 2015 were either unsure of the relationship between nicotine and cancer or incorrectly believed that nicotine caused cancer. And more than a quarter of those surveyed said they believed that low-nicotine cigarettes would be less harmful and addictive than typical cigarettes, beliefs that the researchers called "potentially inaccurate." The authors cited studies that found that only cigarettes with dramatically reduced nicotine content were less addictive than typical cigarettes.

"Incorrectly believing that nicotine causes cancer could discourage smokers from switching to safer nicotine-containing alternatives and could lead nonsmokers to experiment with low-nicotine tobacco products, believing that cancer risk would be reduced," the FDA scientists wrote in the journal Preventive Medicine.

As Lynn Kozlowski, a University of Buffalo smoking and tobacco policy expert notes, nicotine is the only toxin reduced in low-nicotine cigarettes. "It's a full-carcinogen, low-nicotine cigarette," he told me.

Kozlowski is skeptical about the feasibility or even the desirability of mandating that all cigarettes be made of low-nicotine tobacco. "I wouldn't hold my breath about it actually happening," he said.

He points to the FDA's inability to carry out as planned a requirement of the Family Smoking Prevention and Tobacco Control Act, which in 2009 gave the agency the authority to regulate tobacco products. Under the law, the FDA was supposed to add new warning labels to cigarette packages and cigarette ads. The agency announced in 2011 that it would require color graphics depicting smoking's harms along with new warning statements, but it backed down after several tobacco companies challenged the plan in court.

One sign that Big Tobacco might not be more willing to accept a low-nicotine mandate than it did graphic warning labels can be found on the Philip Morris International (PMI) website, where the company states: "Our goal is to develop a portfolio of less-harmful alternative products to continued cigarette smoking. In fact, our aim is that these products, which we call reduced-risk products, will replace cigarettes."

Already, PMI has introduced IQOS, a device for smokers that heats tobacco enough to release a nicotine-containing vapor but not enough to cause it to burn and generate smoke. IQOS is available in about two dozen countries, including Canada but not the United States, according to the company.

Even if low-nicotine cigarettes don't pan out, though, the FDA should still try to educate Americans about how the various sources of nicotine carry different levels of risk, Kozlowski said. That could help persuade smokers to switch from conventional cigarettes to vaping, which he called "far less dangerous."

But if the agency ends up mandating that cigarettes contain nicotine levels below that deemed to be addictive, don't be surprised to see the growth of a black market in conventional cigarettes, Kozlowski said. “Smoking has become quite common among mentally ill individuals and individuals who have other substance use problems,” Kozlowski said, and they will be desperate for cigarettes that contain enough nicotine to satisfy their addiction.

New smokers as well as established smokers will seek out cigarettes with addictive levels of nicotine, no matter what the FDA does, he said. He questioned the assumption that if teens wouldn’t become hooked on smoking if only low-nicotine cigarettes were legal. After all, he said, “when kids get into alcohol, they want the hard stuff. They want to steal a bottle of scotch.”

Eric Donny, a University of Pittsburgh psychologist who studies smoking, agreed that the FDA needs to consider the impact of mandating low-nicotine cigarettes on the black market. But if smokers can get their nicotine fix with non-combustible alternatives, such as vaping and electronic cigarettes, the demand for black market cigarettes is likely to be reduced, Donny said.

Giving smokers the choice of low-nicotine or regular cigarettes “is a reasonable thing,” Donny said. But, he noted, “what we’ve learned is if you provide these in an open market, they don’t compete well.” Offer people who are already addicted to nicotine the choice between a highly addictive cigarette and one that’s less addictive, and “you’re asking them to make a choice as if it’s really a free choice.”

If low-nicotine cigarettes were the only ones on the market, you might assume that people would simply puff on more of them or inhale more deeply to satisfy their nicotine cravings, which would expose them to more of the toxins in the smoke. But Donny says they probably couldn't smoke more to compensate for low-nicotine levels, because "smoke is a toxic thing to inhale. There's a limit as to how much the lungs will take."

In fact, a study led by Donny and funded by the National Institute on Drug Abuse and the FDA found that smokers randomly assigned to smoke low-nicotine cigarettes actually smoked fewer of the cigarettes in the sixth and final week than those assigned to smoke cigarettes with the conventional amount of nicotine. The researchers published their results in 2015 in The New England Journal of Medicine.

"We know that they cheated some," Donny said, referring to the fact that some of those assigned to smoke low-nicotine cigarettes occasionally sneaked some of their regular brand. That suggests that smokers limited to low-nicotine cigarettes will seek out alternative sources to satisfy their addiction, but whether that's e-cigarettes or black market full-nicotine cigarettes remains to be seen, he said.

Still, he and his coauthors concluded, their findings provide preliminary evidence that a substantial reduction in nicotine content is associated with reduced smoking, nicotine exposure and nicotine dependence without serious adverse effects, including nicotine withdrawal.

The low-nicotine cigarettes used in Donny's study came from the 22nd Century Group, which, according to CEO Henry Sicignano, is the only company in the world capable of growing tobacco with non-addictive levels of nicotine.

Sicignano's company licensed its tobacco to Vector to make Quest cigarettes. In the United States today, though, the federal government is the only customer for very-low-nicotine cigarettes. Goodrich Tobacco Company, a wholly-owned subsidiary of the 22nd Century Group, recently received a government order for 2.4 million of its "Spectrum" research cigarettes, 22nd Century announced in June.

According to 22nd Century, government-funded research is trying to answer a number of questions about low-nicotine cigarettes, including how different nicotine levels in cigarettes affect smoking behavior, at what level nicotine is no longer addictive and whether a gradual or an immediate reduction in cigarettes' nicotine content to non-addictive levels is more favorable for smokers.

The company does sell a very-low-nicotine brand of cigarettes in select markets in Spain, Sicignano told me. The “Magic” brand comes in two strengths of nicotine: One is 80% lower than conventional cigarettes, the other 95% lower.

“Our plan was to roll out Magic more broadly, across Europe,” he said. “However, EU (European Union) regulations changed and now prohibit cigarette manufacturers from disclosing nicotine content on their cigarette packs. If you cannot tell the consumer that the cigarette is low-nicotine, we do not believe the product can be differentiated in the very competitive cigarette marketplace.”

On the other end of the spectrum (no pun intended), 22nd Century sells Red Sun "super premium 'extreme nicotine' cigarettes" with a very low tar-to-nicotine ratio in a few select U.S. cities, Sicignano said. He said his company believes that for smokers who aren't interested in cutting back or stopping altogether, high-nicotine cigarettes could allow them to satisfy their nicotine craving but reduce the amount of toxic smoke they inhale. In May, 22nd Century announced that the FDA had authorized the company to conduct a clinical trial of its "Brand B" low tar-to-nicotine cigarettes, made of a proprietary high-nicotine blend. The company says it intends to apply to the FDA to market Brand B as a "modified risk tobacco product."

Of course, the success of high-nicotine cigarettes depends on getting smokers to understand that nicotine doesn't cause cancer.

I’ve been a journalist ever since I edited my elementary school newspaper in Wheeling, W.Va. My father was an ob-gyn, which helps explain why I gravitated toward covering health and medicine, with a special interest in women’s health. As a freelance writer, I’ve written for...